NepMed Repository :: Browsing by Author "Chapagain, S"

Browsing by Author "Chapagain, S"

Now showing 1 - 8 of 8

A Rare Case of Synchronous Renal Cell Carcinoma and Adrenocortical Carcinoma
(Institute of Medicine, 2014) Gupta, DK; Chapagain, S; Subedi, PP; Luitel, BR; Maskey, P; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GK; Joshi, BR
Abstract We report a rare case of synchronous adrenocortical carcinoma and renal cell carcinoma. A 60 year male, a known diabetic and hypertensive under treatment, while undergoing routine investigations and ultrasonography of abdomen, was incidentally detected to have adrenal as well as renal masses. On computed tomograghy scan right adrenal mass measured about 10 x 8 cm while the renal mass was 4.6 x 3.8 cm in size, Urinary vanillylmandelic acid and 24 hr urine metanephrine were within normal limits. Similarly, serum cortisol and dihydroepiandrosterone were in normal range. Patient underwent right adrenalectomy with right partial nephrectomy. Histopathological examination of adrenal mass revealed adrenocortical carcinoma while that of renal mass revealed clear cell renal cell carcinoma. Keywords: Adrenalectomy, adrenocortical carcinoma, renal cell carcinoma
Acute Kidney Injury Secondary to Rhabdomyolysis Due to Wasp Bite
(Kathmandu University, 2023) Chapagain, S; Sah, SP; Chhetri Budhathoki, A; Shrestha, A
ABSTRACT Wasp and bee bites have been well known to cause effects in the human body ranging from minor local skin reactions to deadly anaphylactic reactions. They have also been known to disrupt kidney functions or cause liver injury. The kidney injury associated with wasp bite is a well-known phenomenon, but it is still very rare. We report a case of a 74-year-old man who developed rhabdomyolysis and acute kidney injury, three days after he was bitten by wasp. His symptoms improved after nine days of hospital admission, where he received fluid resuscitation and hemodialysis sessions. This report aims to educate clinicians about the diverse effects of wasp bite for timely diagnosis and management. KEY WORDS Acute kidney injury, Rhabdomyolysis, Wasp bite
Comparison of Different Estimating Equations for Prediction of Glomerular Filtration Rate in Living Kidney Donors
(Institute of Medicine, 2017) Poudyal, S; Pradhan, M; Chapagain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR
Abstract Introduction: Assessment of renal function is a crucial step in evaluation of living kidney donors. The standard method for determining renal function is measurement of glomerular filtration rate (GFR) using I-123 iothalamate, Tc-99m Diethylene Triamine Pentaacetic Acid (DTPA) and 51Cr-Ethylene Diamine Tetraacetic Acid. As these methods are expensive and cannot be used in all clinical settings, it is common practice to estimate GFR by creatinine-based equations. The objective of this study is to compare commonly used estimating equations for the prediction of GFR in Living Kidney Donors. Methods: In 75 healthy kidney donors, GFR estimated by Modification of Diet in Renal Disease Study equation (MDRD), Cockcroft-Gault formula(CG), Chronic Kidney Disease Epidemiology Collaboration(CKD- EPI) equation and 24 hour urinary creatinine clearance were compared to GFR measured by Tc-99m DTPA. Statistical analysis was done using Dunnett’s test and Bland-Altman plot. Similarly, accuracy, precision and bias of each equation were assessed. Results: Mean GFR calculated by DTPA clearance, CG, MDRD, CKD-EPI equations and 24 hour urine creatinine clearance were 83.35±8.59, 78.99±17.17, 93.30±17.12, 96.34±13.36 and 137.96±43.65 ml/min/1.73m2 respectively. Applying Dunnett’s test, GFR by CG equation minimally underestimated GFR measured by DTPA (p=0.612) whereas GFR estimated by MDRD (p=0.034), CKD-EPI(p=0.03) and 24 hour urine creatinine clearance(p<0.001) were statistically significant. CG equation had the highest accuracy. Using Bland-Altman plot, the precision of CKD-EPI equation was the highest among all. Conclusion: There is no single creatinine-based estimating equation to assess GFR with utmost accuracy and precision at the same time. Keywords: creatinine clearance, Diethylene Triamine Pentaacetic Acid, living kidney donors
Factors affecting stone clearance in Percutaneous Nephrolithotomy
(Institute of Medicine, 2018) Poudyal, S; Rai, BDK; Dhital, P; Pradhan, M; Chapagain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR
Abstract Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large and complex renal stones. It is of paramount importance to deliver the maximum clearance with minimal morbidity. There are different anatomical, stone-related and patient-related factors affecting the stone-free rate. This study is conducted to delineate the factors predicting stone clearance in PCNL. Methods: A prospectively maintained database of 114 cases, who underwent PCNL between January to October 2016 in Tribhuvan University Teaching Hospital, was analysed. Age, gender, body mass index, surgical and medical history, renal anomalies, American Society of Anesthesiologists score, tract size, type of tract dilatation, fluoroscopy time, stone density, stone location and burden, skin to stone distance, presence of hydronephrosis, and duration of surgery were correlated with the stone clearance. Stone clearance was evaluated with either X-ray or ultrasound of the kidneys, ureters and bladder up to three months of PCNL. Result: Stone clearance rate was 85.96%. Stone burden(p<0.001), stone location(p=0.03), number of calyces involved by stone(p<0.001) and presence of hydronephrosis(p=0.005) were statistically different between stone-free and stone-residue group. Multifactorial analysis showed that stone burden, location and no. of calyces involved by stone were the only factors effecting stone free rate. Area under curve for the stone burden was 0.842 (p<0.001). Conclusion: Stone burden, location and number of calyces involved by the stone are the principal factors determining the stone clearance in PCNL. Keywords: Percutaneous Nephrolithotomy, Renal calculi, Stone clearance
Non-necrotising Scleritis and Spherophakia in Marfan Syndrome: A Rare Situation Adhering to Hickam’s Dictum
(Kathmandu University, 2025) Parajuli, S; Sharma, S; Shrestha, R; Chapagain, S
ABSTRACT Marfan syndrome is an autosomal dominant, connective tissue disorder that affects various systems of the body including the eyes. We present a case of a 22 year old man with Marfan syndrome presented with a painful red left eye. On examination he was diagnosed to have non-necrotising scleritis and microspherophakia. Non-necrotising scleritis with microspherophakia is a rare and arduous situation. This is an interesting case where Hickam’s dictum prevails over its counter argument of Occam’s razor principle. KEY WORDS Marfan syndrome, Non-necrotising scleritis, Spherophakia
Open Anderson Hynes Pyeloplasty in Ureteropelvic Junction Obstruction: An Institutional Experience
(Institute of Medicine, 2015) Subedi, PP; Chapagain, S; Thakur, DK; Poudyal, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GK
Abstract Introduction: Ureteropelvic junction obstruction (UPJO) is one of the common causes of hydronephros is in children and adults. The cause may be congenital or acquired. The standard management of UPJO has classically been an open Anderson-Hynes (A-H) dismembered pyeloplasty. This study is an audit of A-H pyeloplasty done for patients with UPJO presenting to our institution. Methods: A retrospective analysis was done in the Urology unit, Tribhuvan University Teaching Hospital from July 2013 to November 2014. All patients undergoing A-H pyeloplasty were included for review. Preoperative data regarding the demographics, presentation, diagnostic tools used, details of the surgery, postoperative complications, duration of hospital stay and follow up findings were reviewed. Initial follow up was scheduled at two weeks, then at three months and at one year. At 3 months, DTPA renogram was obtained to assess the function and clearance of the treated kidney. Results: The age of the patients ranged from 5 months to 69 years. Flank pain was the most common presenting complain. Most of the patients were males and left sided obstruction was common. The most common diagnostic modality used was USG and excretory urography. CT urography was done in cases of secondary UPJO. DTPA scan was used in select cases for baseline documentation of the function of the involved kidney. The average duration of surgery was 2 hours and 30 minutes. The mean duration of hospital stay was 5 days. The most common complication was urinary tract infection. Conclusion: Open A-Hpyeloplasty is the most common surgery done for UPJO at our institution. The outcome can be improved by attention to the principles of A-H pyeloplasty. Keywords: hydronephrosis, A-H pyeloplasty, ureteropelvic junction obstruction
Photophobia as a Presenting Feature in Adie’s Tonic Pupil
(Kathmandu university, 2022) Parajuli, S; Sharma, S; Shrestha, R; Chapagain, S; Singh, P; Shrestha, R
ABSTRACT A 34 years old female presented with complains of photophobia since 6-7 months. On examination, she had anisocoria of 4 mm in room light which increased in bright light. The left pupil was dilated and unresponsive to direct and indirect light stimuli. It did however, constrict slowly on near fixation followed by slow re- dilatation on distance fixation. A diagnosis of Adie’s tonic pupil was made since left pupil constricted with instillation of dilute pilocarpine 0.1%. Her symptoms of photophobia and blurred vision immediately resolved. Photochromatic glasses and dilute pilocarpine 0.1% three times a day were prescribed. Prompt symptomatic relief of photophobia and blurred vision was observed. KEY WORDS Adie’s, Anisocoria, Dilated pupil
Risk-based Management of Non-muscle Invasive Bladder Cancer: Experience from Tribhuvan University Teaching Hospital
(Kathmandu University, 2016) Luitel, BR; Chalise, PR; Sidharth; Gupta, DK; Subedi, P; Chapagain, S; Sharma, UK; Gyawali, PR; Shrestha, GK; Joshi, BR
ABSTRACT Background Most of the recent evidences suggest for risk-based management of non muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. Objective This study was conducted to assess the recurrence and progression of non muscle invasive bladder cancer in Nepalese patients using European Organization for Research and Treatment of Cancer (EORTC) risk tables and to assess the effectiveness of intravesical therapy to reduce the risk of recurrence. Method A prospective observational single centre study was conducted at Tribhuvan University Teaching Hospital from January 2010- December 2012. Forty six patients with non muscle invasive bladder cancer who underwent transurethral resection of bladder tumor and completed two years follow up were included. According to the European Organization for Research and Treatment of Cancer (EORTC) risk table, the patients were divided into low, intermediate and high risk groups. The patients received postoperative adjuvant therapy and surveillance as per the European Association of Urology guidelines. Result Among the 46 patients, the overall two year recurrence and progression rate was 8 (17%) and 1 (2%) respectively. Out of seven patients in low risk category, none of them developed recurrence or progression of disease. Out of 15 patients in intermediate risk category the one year and two year recurrence rate was 13% and 20% respectively. Out of 24 patients in high risk category the one and two year recurrence rate was 17% and 21% respectively. The risk reduction by use of intravesical Bacillus Calmette Guerin (BCG) for recurrence in high risk category was 58% and 60% in first and second year respectively. In our study, the overall and individual risk group, the one and two year recurrence rate was lower than that predicted by European Organization for Research and Treatment of Cancer risk table. Conclusion Risk-based management of non muscle invasive bladder cancer by using the European Organization for Research and Treatment of Cancer risk table is a useful method of management, though its prediction rates are lower in Nepalese population. KEY WORDS EORTC, intravesical therapy, NMIBC, progression, recurrence, risk table

Browsing by Author "Chapagain, S"

Results Per Page

Sort Options